The Impact of DNP Education

in Shaping Health Care Systems

for the Future

Jacqueline Dunbar-Jacob, PhD, RN, FAAN

Heba Khalil, PhD(c)

University of Pittsburgh

Objectives

1. Review why we are designing DNP programs

2. Review growth of the DNP degree

3. Describe variations in programs

4. Discuss value and contributions of the DNP

How Did We Get Here?

Institute of Medicine – National Academies Press

1. Crossing the Quality Chasm: A New Health System for the 21st Century (2001; 2003)

2. To Err is Human: Building A Safer Health System (1999; 2003)

3. Health Professions Education: A Bridge to Quality (2003; 2003)

These Reports Called For:

System Redesign

Emphasis of Safety and Quality Improvement

Use of Evidence-Based Practice

Ability to Find and Evaluate

Patient Centered Care

Use of Technology and Informatics

Ability to Develop Self-Management Skills

Interdisciplinary Team Based Care and Education

American Association of

Colleges of Nursing

2004

Voted to Endorse the Position Statement

on the Practice Doctorate in Nursing

Advancing the Nation’s Health Needs:

NIH Research Training Programs

National Research Council

of the National Academies, 2005

“The need for doctorally prepared

practitioners and clinical faculty would

be met if nursing could develop a new

non-research clinical doctorate…”

p. 74

American Association of

Colleges of Nursing

2006

Voted to Endorse the

“Essentials of Doctoral Education for

Advanced Nursing Practice”

With a Goal of Moving the

Master’s Level of Preparation for APRN’s

to the Doctoral Level by 2015

The 2006 Essentials Included

Preparation for:

Nurse Practitioners

Nurse Clinical Specialists

Nurse Anesthetists

Nurse Midwives

Nurse Administrators

The AACN Position Called For The:

“DNP Curriculum (to) build on traditional

master’s programs by providing an

education in evidence-based practice,

quality improvement, and systems

leadership, among other key areas”

With a Strengthened Clinical Component

“Programs should provide a minimum of

1000 hours of practice post-baccalaureate as

part of a supervised academic experience…

designed to help students build and

assimilate knowledge for advanced specialty

practice at a high level of complexity”

Increased Hours are Consistent with

Other Clinical Disciplines at the

Doctoral Level Applying For Licensure

PhD or PsyD in Psychology

“An approved internship… 1200 hours”

“An applicant shall complete 1 year of

post-doctoral acceptable supervised

experience… at least 12 months consisting

of at least 1,750 hours of experience”

Nurse Anesthesia

2011 Council on Accreditation

Voted to Initiate a Major Revision to

Standards for Accreditation

Redefine Entry Into Practice to Require

Doctoral Level Preparation by 2025

Doctor of Physical Therapy

“The applicant shall have a minimum of

two full time clinical internships of at

least 800 hours total, which are

supervised by a physical therapist.”

(PA Code)

Where Have We Arrived in DNP Education?

2011: 184 programs (101 planning)

9,094 enrolled

1,581 graduates

Compared with PhD Education

2011: 125 programs

4,907 enrolled

601 graduates

Current DNP Program Statistics

DNP programs are now available in

40 states plus the District of Columbia

States with the most programs (8 or more)

include Florida, Massachusetts,

Minnesota, New York, Texas, and

Pennsylvania

Current DNP Program Statistics

184 DNP programs are currently enrolling

students at schools of nursing nationwide,

and an additional 101 DNP programs are

in the planning stages

65 schools in USA offer BSN-DNP track

164 schools in USA offer MSN-DNP track

What Do DNP Programs Look Like?

Example of Pennsylvania

Pennsylvania DNP

Pennsylvania is one of the US states with the

most DNP programs with Florida, Massachusetts,

Minnesota, New York, and Texas.

14 universities are currently enrolling students in

the DNP at schools of nursing statewide.

PA Governor Corbett signs Higher

Education Modernization Act, which

permits state universities to offer applied,

or professional, doctorates (07/10/12)

The number of DNP programs will grow

DNP Tracks

BSN-DNP track (4)

MSN-DNP track (14)

MSN-DNP Specialty Area

NP

Adult-Gerontology Acute Care

Gerontology-Primary Care

Family

Neonatal

Pediatric Primary Care

Adult-Pediatric Psychiatric

CNS

Adult Emergency/Critical Care

Adult-Gerontology/Acute Care

Nurse Anesthesia

MSN-DNP Specialty Area

Advanced Nursing Practice

Healthcare Policy

Informatics

Clinical Leadership

Nursing Administration

Nurse Executive

Population-Based Specialties

BSN-DNP Track Length

The length of BSN-DNP program varies

and depends on the specialty area with

the range of 58-93 credit hours

BSN-DNP Specialty Area

NP

Adult-Gerontology Acute Care

Geriatric-Primary Care

Family

Neonatal

Pediatric Primary Care

Adult-Pediatric Psychiatric

BSN-DNP Specialty Area

CNS

Adult Medical/Surgical

Adult-Gerontological

MSN-DNP Track Length

The length of MSN-DNP program varies

across the state’s schools and specialties,

with the range of 27-50 credit hours

Pennsylvania - Specialties

BSN-DNP

2 NP

2 CNS

2 None Specified

Pennsylvania - Specialties

MSN-DNP

7 Leadership/Administration

5 NP

2 CNS

2 CRNA

1 Education

1 Clinical Scholar

4 None Specified

Distribution of DNP Graduates

Administration/Leadership 378

Nurse Practitioner 189

Other 22

Placement of DNP Graduates (N=163)

78 Acute Care

53 Academics

24 Primary Care

8 Other

Shaping a

Health Care System

Early Impact –

Acute Care Leadership

New Skills

Quality Improvement

Evidence Based Practices

Collaborative Team Care

Appreciation of Informatics

System Redesign

Quality Improvement

Evidence Based Practices

Collaborative Team Care

Appreciation of Informatics

System Redesign

Case Studies

Director Medicare/Medicaid Program –

Insurance Company

Director Academic-Service Partnership –

Academic Health Center

CEO – Academic Hospital (ABC)

Shaping a

Health Care System

Early Impact – Academic

New Contributions

Clinical and System Depth

Added Competencies for Students

Quality and Safety

Team Practices

Evidence Based Practice

Secondary Contributions

Academic Department Equivalence

Methodologic Expansion, e.g.

Program Evaluation

Improvement Science

Implementation (T3-translation) science

Clinical-Faculty Collaborations

Modeling Advanced Education for Students

Enhanced Respect

Case Studies

Pitt – moving to 100% doctoral prepared faculty

Pitt – distinction between professional and

research doctoral students

Shaping a

Health Care System

Early Impact – Primary Care

Secondary Contributions

Enhanced Precepted Education

Expanded Educational Opportunities

Other Discipline ‘Peer’ Perception

Case Studies

Nurse Owned Practice

Interdisciplinary Practice and Crosswalk

Event Medical Booth

New Contributions

Practice Innovations

Clinical Depth

Interdisciplinary Team Care

Systems Management

Evidence-Based Care

Long-Term Impact On Health Care Systems

Will Depend On

The Type And Quality Of

Other Programs

Original Intent Of DNP was Advanced Practice

Early Program Emphasized

Leadership/Administration

Where Do We Want To Have Impact?

Do We Want the DNP to Top Off the MSN

or

Do We Want a Single Integrated Program?

Majority of Programs Add Content

(27-54 credits)

to MSN degree

Case Example

University of Pittsburgh DNP program

BSN-DNP Foundational Curriculum

MSN maps onto BSN-DNP curriculum

Post-MSN students considered as transfer students

Course program tailored to students

Contrasts with standard course work for DNP

Each specialty has its curriculum (8)

with a core across programs

Graduation diploma/transcript includes

degree – program – area of concentration

1000 clinical hours in specialty

University Requirement For Minimum

of 81 Credits (post-baccalaureate)

for a Doctoral Degree

Post-MSN has Online Option

Attractive to distance students

Student advisory board indicates

preference for onsite – online is

convenience default

Educational Challenges

Qualified Faculty Each Specialty

Qualified Capstone advisors

Faculty Education

Academic-Service Partnerships

Qualified Clinical Preceptors

Competition of the MSN

2012 Closed Admission to

MSN Advanced Practice Programs

MSN programs: Administration

Informatics

CNL

DNP Education Can Enrich

Acute care and primary care settings

Quality of the educational environment

Academic-service partnerships

Interprofessional relationships

Impact Will Depend

Upon the Quality and Focus

of the Programs

Administration – Advanced Practice

Master’s Top Off – Integrated Preparation

Depth of Content

Placement

Can We Reach Them?

Opportunities are Extensive

Can We Reach the DNP

for APRN’s by 2015?